A Pilot Stress Management Intervention for High Risk Children with Asthma

描述(由申请人提供)： 哮喘是美国儿童中最常见的慢性病，在生活在城市地区的少数族裔和社会经济弱势儿童中，发病率和死亡率高得不成比例。哮喘患病率的差异不能完全解释这些差异，突出了针对与哮喘控制较差相关的因素进行干预的必要性。越来越多的证据表明，伴随着社会经济劣势的心理社会因素导致了儿童哮喘发病率的显著差异，心理压力预示着儿童哮喘的未来恶化。慢性应激和较低的社会经济地位也与对环境诱因的呼吸道炎症反应加剧和炎症过程上调有关，这些炎症过程直接与哮喘加重有关。有证据表明，压力会加剧呼吸道炎症，并预测哮喘发病率，这增加了旨在帮助儿童管理压力的心理干预可能会改善哮喘高危儿童的身体健康的可能性。到目前为止，儿童哮喘的心理社会干预研究总体质量较差，突显出需要进一步进行更严格的研究。因此，我们开发了一个基于认知行为疗法原则的压力管理和应对技能培训计划(I Can Cope)。初步试验为向城市学校8-12岁的哮喘患者提供补充干预的可行性提供了初步支持，并提供了初步证据，表明干预相关的压力感知减少和肺功能的改善(通过肺活量测定法测量)。拟议研究的主要目标是对这种以学校为基础的干预措施的有效性进行关键的随机对照试点评估，以获得开展全面临床试验所需的数据。为此，我们建议随机将108名患有医生确认的哮喘的经济困难的城市3-6年级学生随机分配到基于学校的干预或仅受教育控制的条件下。主要结果将包括(1)心理功能和(2)哮喘健康，如在干预期结束时评估的。如果未来的工作证实了我们最初的可行性发现，这将是第一个证明以学校为基础的哮喘压力管理干预对生活在城市环境中的高危儿童的健康益处的研究，提供了一种新的干预手段，以减少哮喘发病率的差异。此外，它将提供一种比以诊所为基础的个人干预更有效和更具成本效益的方法来接触弱势儿童，而我们认为这并不可行。 公共卫生相关性： 生活在美国城市地区的少数族裔和社会经济弱势儿童患哮喘的风险高得不成比例，哮喘严重程度的差异更大 比哮喘患病率高。越来越多的证据表明，伴随着社会经济劣势的心理社会因素可能在这些差异中发挥作用，心理压力预示着儿童未来的哮喘恶化。目前的申请建议进行一项试点研究，审查第一次以学校为基础的干预措施，以针对这一可改变的风险因素。因此，该项目对公众健康的影响是相当大的，包括确定 一种干预方法，以减少哮喘发病率的差异。此外，我们预计干预措施将具有成本效益，减少就医、按需使用药物和缺课。 (摘要结束)

DESCRIPTION (provided by applicant): Asthma is the most common chronic illness among children in the United States, with disproportionately high morbidity and mortality among minority and socioeconomically disadvantaged children living in urban areas. These disparities are not fully accounted for by differences in asthma prevalence, highlighting a need for interventions targeting factors associated with poorer asthma control. Converging evidence suggests that psychosocial factors that accompany socioeconomic disadvantage contribute to the marked disparities in childhood asthma morbidity, with psychological stress predicting future asthma exacerbations in children. Chronic stress and lower socioeconomic status also are associated with the exacerbation of airway inflammatory responses to environmental triggers and the upregulation of inflammatory processes directly implicated in asthma exacerbation. Evidence that stress accentuates airway inflammation and predicts asthma morbidity raises the possibility that psychological interventions aimed at helping children manage stress could improve the physical health of high risk children with asthma. To date, studies of psychosocial interventions for pediatric asthma have been of poor general quality, highlighting a need for further more rigorous research. Accordingly, we have developed a stress management and coping skills training program based on the principles of cognitive behavioral therapy ("I Can Cope"). Preliminary trials provide initia support for the feasibility of offering this supplemental intervention to 8-12 year old asthmatics n urban schools and provide initial evidence for intervention-related decreases in perceived stress and improvements in lung function, as measured by spirometry. The primary objective of the proposed research is to conduct a critical randomized controlled pilot evaluation of the effectiveness of this school-based intervention to obtain data that is necessary to develop a full-scale clinical trial. For this purpose, we propose randomly assigning 108 economically disadvantaged urban 3rd through 6th graders with physician-confirmed asthma to the school-based intervention or an education only control condition. Primary outcomes will include (1) psychological function and (2) asthma health, as assessed at the end of the intervention period. If future work confirms our initial feasibility findings, this will be the first study to demonstrae the health benefit of a school-based asthma stress management intervention for high risk children living in urban settings, providing a novel means of intervening to reduce disparities in asthma morbidity. Furthermore, it will provide a more efficient and cost-effective means of accessing vulnerable children than individual clinic based intervention, which we have not found to be feasible. PUBLIC HEALTH RELEVANCE: Minority and socioeconomically disadvantaged children living in urban areas in the US are at disproportionately high risk for asthma morbidity, with disparities in asthma severity being larger than those in asthma prevalence. Growing evidence shows that psychosocial factors that accompany socioeconomic disadvantage may play a role in these disparities, with psychological stress predicting future asthma exacerbations in children. The current application proposes a pilot study examining the first school-based intervention to target this modifiable risk factor. Thus, the public health implications of the project are considerable and include the identification of a method of intervening to reduce disparities in asthma morbidity. In addition, we anticipate that the intervention will be cost effective, reducing medical visits, use of as needed medications, and school absenteeism. (End of Abstract)